The process of maintaining hope in adults under–going bone marrow transplantation

ArticleinOncology nursing forum 19(6):883-9 · August 1992with11 Reads
Source: PubMed
Abstract
The purpose of this qualitative study was to explore the processes of hoping in adults undergoing bone marrow transplantation (BMT) for leukemia. Grounded theory methodology was used to elicit the experience of hoping in 10 men and 10 women, ages 20-58, who had undergone BMT. The central process described by participants was that of maintaining hope. The core categories used to describe this process were Dealing With It and Keeping It in Its Place. Dealing With It is defined as the process of confronting the negative possibilities inherent in the illness experience and allowing the full range of thoughts, behaviors, and emotions resulting from this confrontation. Keeping It in Its Place is defined as the process of managing the impact of the illness by controlling or limiting one's response to the disease and therapy. The relationship between these two contradictory core categories is explained by The Dialectic of Maintaining Hope. This dialectic is defined as the synthesis of the antithetical strategies of Dealing With It and Keeping It in Its Place in which people are able to transcend each strategy and sustain hope. The findings provide a nascent, explanatory model and information for nurses regarding an important adaptive process.

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  • ... • Της Διατήρησης-"Keeping it in its place" : η οποία ορίζεται ως η διεργασία της διαχείρισης της επίδρασης της ασθένειας με το να ελέγχονται ή να ελαχιστοποιούνται οι αντιδράσεις κάποιου από την ασθένεια και τη θεραπεία. Η σύνθεση των προαναφερθέντων κατηγοριών επιτρέπει στο άτομο να διατηρήσει την ελπίδα του και να διαχειριστεί την απειλή την οποία βιώνει (Ersek, 1992). Η δεύτερη μελέτη (Saleh & Brockopp, 2001) χρησιμοποίησε φαινομενολογική μέθοδο για να αναλύσει τις αφηγήσεις εννέα ασθενών που νοσηλεύονταν για μεταμόσχευση αιμοποιητικών κυττάρων. ...
    ... •Στις απαντήσεις του ανέφεραν ότι ήταν αρκετά χρήσιμο γι' αυτούς να συναντούν άλλους στην ίδια κατάσταση και να ονομάζουν τα συναισθήματά τους Ersek, M. (1992), "The process of maintaining hope in adults undergoing bone marrow transplantation for leukemia". Oncology Nursing Forum 19 (6), 883-889. ...
  • ... Si bien esta es importante para la salud y el bienestar, muchos estudios la evalúan a través de entrevistas con los pacientes o familiares (Benzein E, Norberg A. & Saveman, 2001; Benzein & Saveman, 1998; Ersek, 1992ejemplo la Nowotny Hope Scale (nhs) (Nowotny, 1989), la Miller Hope Scale (mhs) (Miller & Powers, 1988) y la Herth Hope Scale (hhs) (Herth, 1992 ), estas son demasiado largas (constan de 29, 40 y 30 ítems respectivamente ), por lo que se consideran inadecuadas tanto en la práctica como desde el punto de vista ético (Benzein & Berg, 2003). La medición de la esperanza requiere de instrumentos con una base teórica sólida, adecuadas propiedades psicométricas y facilidad de uso. ...
  • ... Dealing with feelings of uncertainty and the fear of dying were the most common emotional responses reported. Indeed in a study conducted in patients with acute and chronic leukaemia illness was perceived both as a threat to one's ability for future planning and a threat to their life (Ersek, 1992). Living in their shrinking world, patients with acute leukaemia mentioned the importance of interpersonal relationships. ...
    ... Results from this thematic synthesis suggest that hope played a buffering role as it facilitated patients' coping process. In an early study in patients with acute and chronic leukaemia maintaining hope was seen as a dual action process: dealing with leukaemia and at the same time keeping it in its place (Ersek, 1992). This means that patients try to face and cope with their illness and at the same time preserve a sense of normality in their life. ...
  • ... Assessment of control: sense of control is important in maintaining hope (Bunston, mings, mackie, & Jones, 1995;Ersek, 1992;Farran et al., 1995;Flemming, 1997). Women described experiences that supported and threatened their sense of control. ...
  • ... Cognitive strategies are used by persons who are dying and their families to decrease the psychological distress accompanying this state. Ersek (1992) noted hope-sustaining strategies of the dying such as (a) " dealing with it, " which means confronting the negative outcomes and allowing the full range of thoughts and possibilities, and (b) " keeping it is its place, " a process of managing the impact of the disease by controlling one's response to the disease, prognosis, and therapy, avoiding negative aspects. Taylor (1989) describes cognitive illusions as patterns of thinking, including error and bias that may provide comfort and adaptation to threats including impending death. ...
  • ... TMT researchers posit that the unspecified " subtle reminders of death " embedded in mortality salience manipulations activate processes that occur outside of the individuals' consciousness (Pyszczynski, Greenberg, Solomon, Arndt, & Schimel, 2004, p. 439). Conversely, for a terminal cancer patient or for a person who believes that he or she has actually died in a car crash and has come back from the other side, the subject of mortality has become a tangible, experiential fact of life that is systematically integrated into their thoughts and behaviors (e.g.,Ersek, 1992;Ring & Elsaesser Valarino, 1998). Individuals facing their mortality in this context are provided specific answers to many of the typical unknowns surrounding their death, such that they know how they will die or (in the case of NDE survivors) how they believe they actually did die. ...
  • ... Wright and Shontz (1968) identified seven structures of hope that could emerge from a dialectical process involving ''being encouragement,'' ''reality surveillance,'' ''worrying,'' and ''mourning''. Ersek (1992) found hope in a sample of 20 adult patients undergoing bone marrow transplantation as a dialectical process of reconciling in terms of keeping illness in its place by appraising illness as a threat or non-threat, and managing emotions and working through it in a way that fosters/sustains hope. It is also considered a dynamic pattern that results from changing nature of human feelings and experiences connected with individuals' differing circumstances of living and experiencing (Morse and Doberneck, 1995). ...
    ... The conceptualization of hope adopted generally in nursing needs to be challenged on two accounts based on the findings of this study. The first point is related to the conceptualization of hope in which the structure of hope is identified to encompass goal orientation and realistic cognitive process (Wright and Shontz, 1968; Ersek, 1992; Morse and Doberneck, 1995) and the measurement of hope that includes goal orientation as an attribute (Farran et al., 1995). Contrary to such thinking, goal orientation as a key feature in structuring hope is not found in any of the patterns identified in this study. ...
  • ... In the face of personal loss, it is thought, individuals go through this same rebuilding of their shattered worlds, often creating new, superior life structures and assumptions (Janoff- Bulman, 1992; Tedeschi et al., 1998). Support for this " rebuilding model " can be found among cancer patients , for example, whose growth outcomes include positive coping, increased hopefulness, and a sense of transcendence (Ersek, 1992; Steeves & Kahn, 1987; Taylor, 1993). Many of the same dramatic positive life changes witnessed in PTG studies are ubiquitous in the study of the near-death experience. ...
    ... In the face of personal loss, it is thought, individuals go through this same rebuilding of their shattered worlds, often creating new, superior life structures and assumptions (JanoffBulman, 1992; Tedeschi et al., 1998). Support for this " rebuilding model " can be found among cancer patients , for example, whose growth outcomes include positive coping, increased hopefulness, and a sense of transcendence (Ersek, 1992; Steeves & Kahn, 1987; Taylor, 1993). Many of the same dramatic positive life changes witnessed in PTG studies are ubiquitous in the study of the near-death experience. ...
  • ... These present ®ndings support the earlier works by McGee (1984), Hinds (1988), and Owen (1989) and further support that hope not only requires an initial investment of energy but also gives off energy. The need constantly to manage negative outside factors and to foster one's inner sense of hope in order to remain hopeful was identi®ed earlier by Ersek (1992) in bone marrow transplant patients. Adolescents in this study focused their hopes onòthersonòthers' in contrast to only`selfonly`self', similar to seriously ill adolescents in a study by Hinds (1988). ...
  • ... Farran and colleagues (1995) argued that the first two categories directly support the relational and spiritual/transcendent attributes of hope. The second study explored the process of maintaining hope in individuals undergoing bone marrow Hope Development 36 transplantation for leukemia (Ersek, 1992). Interviews were conducted at three intervals and four components of the process of maintaining hope emerged: appraising the illness as a threat, allowing the emotional responses, working through them, and moving on. ...
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